John V. Redington

Left Ventricular Performance before and after Removal of the Noncontractile Area of the Left Ventricle and Revascularization of the Myocardium

The left ventricular volume and the internal surface areas of noncontractile regions were measured by cineangiocardiography at 60 frames/sec in nine patients with a chronic localized noncontractile area of the left ventricle. Arteriosclerotic heart disease was proven in eight patients by means of coronary arteriography. Left ventricular end-diastolic pressure, stroke volume, ejection fraction, mean circumferential shortening, and cardiac output were also measured before and after removal of the noncontractile area and revascularization of the myocardium.The noncontractile areas, measured at end-diastole, ranged from 12 to 40% of the internal surface area of the left ventricle. Generally, impairment of the left ventricular function depended on the size of the noncontractile areas. The end-diastolic volume was approximately 150 ml/m2 when the size of noncontractile areas exceeded 20-25% of the left ventricular surface area (r = +0.72; P < 0.05). The ejection fraction decreased as the size of the noncontractile areas increased (r = −0.81; P < 0.01). Following surgery, the left ventricular function, as well as the clinical condition, improved significantly, although the cardiac performance remained in the abnormal range in most patients. The ejection fraction increased (P < 0.05), and the percent circumferential shortening also improved (P < 0.05).Removal of the noncontractile area of the left ventricle and revascularization of the myocardium improved the cardiac performance and increased the sense of well being in these patients.

Carcinoid heart disease. Surgery for tricuspid and pulmonary valve lesions.

The second known successful operation for carcinoid valvular heart disease is reported. The patient underwent tricuspid valve replacement and pulmonary valvotomy and has no symptoms of heart disease more than 1 year after operation.

Surgery for Ebstein's Anomaly

Abstract The surgical treatment of Ebsteins anomaly is discussed from our experience with 5 patients who underwent successful operation together with 32 previously reported patients. Tricuspid valve replacement with a disc valve and primary closure of the atrial septal defect was performed in our 5 patients. In 3 patients plication of the atrialized ventricle with paradoxical movement was also employed. In the remaining 2 patients plication was not necessary. We believe that tricuspid valve replacement will usually be required for these patients. The low-profile Kay-Shiley disc valve with the Kay muscle guard is well suited for tricuspid valve replacement in patients with Ebsteins anomaly. The prosthesis should be placed above the coronary sinus to avoid injury to the conduction system. Elimination of the atrialized ventricle is an essential aspect of the procedure when paradoxical distention persists following repair or replacement of the tricuspid valve. Primary closure of the atrial septal defect also should be performed. All 5 of our patients were improved and remain in good condition four months, eleven months, one and one-half years, one and three-fourths years, and five years, respectively, following operation.

The electrical impedance cardiogram in health and disease

Abstract 1. 1. The electrical impedance cardiogram (ICG) records continuous changes in heart shape throughout the cardiac cycle. It can be recorded on any direct writing electrocardiograph. 2. 2. Certain electrical impedance cardiograms closely resembled mechanical displacement recordings of heart motion (apexcardiograms), indicating a related origin. 3. 3. Tracings from normal subjects resembled each other, but tracings from patients with known cardiac deformities differed from the normal. 4. 4. Atrial activity was recorded selectively. 5. 5. Paradoxical bulges of the left ventricle produced characteristic abnormalities in impedance cardiograms. 6. 6. The impedance cardiogram can be used to analyze dynamic dysfunctions of the heart.

Intracardiac foreign body simulating double-chamber right ventricle.

Abstract Initiated by the introduction of a wooden splinter into the heart at age 5 years, a continuous morphologic change of the right heart chambers and the tricuspid valve took place over a period of 54 years. Clinical and angiographic findings indicated a double-chambered right ventricle and tricuspid regurgitation caused by endocardial and myocardial fibrosis that eventually resulted in marked heart failure. The patient was operated on at age 59, the foreign body was removed from the right ventricular cavity, and the tricuspid valve was replaced with a prosthetic disc valve with a muscle guard. After this procedure, the patients condition improved significantly.

The Surgical Treatment of Mitral Insufficiency Associated with Torn Chordae Tendineae

In 1963 Kay and Egerton 1 and in 1965 Kay, Tsuji, and Redington2 reported on the surgical treatment of mitral insufficiency associated with torn chordae tendineae.